Basic Information
| Provider Information | |||||||||
| NPI: | 1558375535 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MERCER BUCKS HEMATOLOGY/ONCOLOGY PC | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | BELLEVUE HEMATOLOGY/ONCOLOGY PC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 CAPITAL WAY | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093030747 | ||||||||
| FaxNumber: | 6093030773 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 CAPITAL WAY | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093030747 | ||||||||
| FaxNumber: | 6093030773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 02/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | DE ANGELIS | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6093030747 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 558626 | 01 | NJ | AETNA | OTHER | 1014049 | 01 | NJ | HNJH | OTHER | CC8694 | 01 | NJ | RAILROAD MEDICARE | OTHER | 0113767000 | 01 | NJ | AMERIHEALTH | OTHER | 1523708 | 01 | NJ | UMWA | OTHER | 0113767000 | 01 | NJ | KEYSTONE | OTHER | 3046303 | 05 | NJ | MEDICAID |